Healthcare Provider Details

I. General information

NPI: 1346317427
Provider Name (Legal Business Name): COLEMAN PROFESSIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5982 RHODES RD
KENT OH
44240-4128
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-4128
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-1347
  • Fax: 330-678-3677
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-678-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0227
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0227
License Number StateOH

VIII. Authorized Official

Name: MRS. DIANA D. KEATHLEY
Title or Position: HR COORDINATOR
Credential:
Phone: 330-676-6875